Severed Achilles Tendon?

[Simusid]

I saw a photo recently of a 20 something female that was locked out of her house. She decided the best way to get in was to kick out a window (alcohol MAY have been a factor). The photo was of her foot showing a clean cut a few inches above her malleolus and the comment said that the achilles tendon was cleanly severed.

My question, and obviously this is not a pre-hospital issue, is how is that corrected? Is it possible to stitch a cut tendon back together or will she need a replacement?

 

[Veneficus]

I saw a photo recently of a 20 something female that was locked out of her house. She decided the best way to get in was to kick out a window (alcohol MAY have been a factor). The photo was of her foot showing a clean cut a few inches above her malleolus and the comment said that the achilles tendon was cleanly severed.

My question, and obviously this is not a pre-hospital issue, is how is that corrected? Is it possible to stitch a cut tendon back together or will she need a replacement?

Surgically.

One of the most common ways is to cut down part of the muscle, invert it, and sew it.

I have directly repaired tendons in the fingers by simply sewing them together, but I am not convinced that would even work with the Achilliles.

edit: apparently a purse-string stitch on both sides and tied together can sometimes work. But I have still only ever seen the muscle flap used.

 

[Simusid]

Thanks that is interesting. I was pretty sure that tendons can be repaired. I was unsure whether one like the Achilles, that takes such a load and a beating, could be repaired strongly enough.

 

[shfd739]

Surgically.

One of the most common ways is to cut down part of the muscle, invert it, and sew it.

I have directly repaired tendons in the fingers by simply sewing them together, but I am not convinced that would even work with the Achilliles.

edit: apparently a purse-string stitch on both sides and tied together can sometimes work. But I have still only ever seen the muscle flap used.

A co-worker had his repaired 4-5 months ago with the purse-string method after severing it playing basketball. No direct trauma-he turned and it snapped.

So far it's healed fine.

 

[VirginiaEMT]

I saw a photo recently of a 20 something female that was locked out of her house. She decided the best way to get in was to kick out a window (alcohol MAY have been a factor). The photo was of her foot showing a clean cut a few inches above her malleolus and the comment said that the achilles tendon was cleanly severed.

My question, and obviously this is not a pre-hospital issue, is how is that corrected? Is it possible to stitch a cut tendon back together or will she need a replacement?

I have had a Achilles tendon surgically repaired because of being a middle aged man acting like a kid playing softball. Yes, It can be repaired but will never be the same.

 

[Doczilla]

Do they teach you guys how to test for an Achilles tendon rupture or tear? Whoever knows without having to look it up (honor system) gets a cookie.

 

[Akulahawk]

Do they teach you guys how to test for an Achilles tendon rupture or tear? Whoever knows without having to look it up (honor system) gets a cookie.

Just flex the knee and then squeeze the gastrocnemius muscle... aka Thompson Achilles test.

I'll take my cookie. BTW, I learned to do that test back in 1991 or 1992 or so... not as part of any EMS course I have ever taken.

 

[Veneficus]

"stand on your toes"

if they can't, it is at least damaged.

I want a cookie too

 

[Akulahawk]

"stand on your toes"

if they can't, it is at least damaged.

I want a cookie too

If they can't stand on their toes, while it is not definitive for the Achilles tendon, you at least know that something between the calcaneous and gastrocnemius muscle insertion on the femur is damaged. That could include the soleus muscle as well as some toe extensor muscles.

The Thompson's test is more specific, but you would also probably have a palpable defect in the Achilles tendon at the same time.

Of course in this day and age, I would expect that a number of physician level providers would probably also want some imaging…